Is ownership important?

There was a debate on LinkedIn recently about personal health records, and about what 'patient control' meant. A fairly prevalent view was that the question of who 'owned' the record was irrelevant.Yet it seems to me that ownership is easily the most important aspect of a health record.

I realise I'm in a minority on this issue. I was therefore interested to read yesterday from Sir Ian Kennedy (http://bit.ly/eWVAIr):

I begin with the culture of professionals.The professional owns knowledge. From this, as I suggested in the Reith Lectures, flows power.And, power here is used in a neutral, descriptive sense. Speaking in general terms, and conscious that, being general, we all know of exceptions, the patient is someone in the professional’s power whom the professional seeks to care for.The professional grants the patient the benefit of his/her knowledge, but does so on terms.The fundamental term is that the professional remains in charge of the exchange. Yes, the patient may be granted the autonomy to make a choice, but it is an autonomy granted by the professional, rather than owned by the patient.
The striking feature of this analysis is that the relationship between patient and professional is not perceived as one of service.The professional is simply not at the patient’s service.Thus, analogies with relationships more obviously characterised by the notion of service are out of place. (And this is equally true of the two other ancient professions, the law and the church.) Introducing the rhetoric of the market, in the form of there being a commercial relationship between the patient and the professional, does not change this dynamic.The fact that the patient is paying the bill has to be managed by the professional. Manners may change a little, but little else. Power is not relocated. Indeed, the very word “service” is too close to “servile” to many a professional’s ear.To repeat, the professional in healthcare is not like, does not see her/himself as a on a par with, a restauranteur, an electrician, a hotelier, or a shopkeeper.To all of these “the customer is always right”.To the professional in healthcare, the word customer sticks in the throat, given its symbolic quality of being the
more important player in the exchange, and is not right.The patient is there to be guided, advised, led, but not in charge.And, none of this analysis is intended to deny for a moment that the vast majority of professionals are immensely caring and supportive people, committed to doing their best for their patients. What I am seeking to understand is some kind of cultural characteristics which constitute the DNA of professionals. 

This consideration does not suit existing suppliers, who are struggling to get clinicians interested in electronic records. But in the longer term a more patient-owned approach to information will be part of new forms of professionalism.

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